Chronic kidney disease (CKD) in Mesoamerica is a leading killer of workers in agricultural communities. The objective of this proposal is to examine whether symptoms and injuries that sugarcane workers experience may also be adversely impacting kidney function. Heat stress, volume depletion, and muscle injury have been theorized to play a role in developing CKD. Many previous studies of CKD in Mesoamerica are cross-sectional or examine change in kidney function over a relatively short period of time. In the proposed research, we will investigate this issue in a study of 243 sugarcane industry with different jobs. We have available complete work histories for all subjects and medical records with details of each medical visit abstracted. These provide information on whether workers experienced dysuria, exhaustion, muscle injury, or back injury. For Aim 1, we will examine whether medical visits for these reasons occurred disproportionately by job type. In particular, cane cutters are thought to endure the most intense heat and greatest physical exertion. Next, we're interested in whether dysuria, exhaustion, muscle injury, or back injury are more likely to lead to long-term kidney change. For Aim 2, we will evaluate if workers seeking medical care for these reasons experienced a more rapid decline in estimated glomerular filtration rate (eGFR), an indicator of kidney function. Study follow-up covers up to 14 years, and is positioned to make critical contributions to our understanding of factors affecting CKD in afflicted agricultural communities. This work relates closely to the National Institute for Occupational Safety and Health (NIOSH)'s Agriculture, Forestry and Fishing Sector. It also aligns with two Cross-Sectors: Cancer, Reproductive, and Cardiovascular Diseases; and Occupational Health Disparities as Hispanic workers disproportionately work in some of the more dangerous jobs. This research aligns with the NIOSH Research to Practice goals because it will identify medical conditions for which intervention can occur prior to development of a chronic condition.